The purpose of this study is to evaluate the efficacy and safety of galantamine treatment in patients with mild cognitive impairment.

This is an international, multicenter, double-blind, randomized, placebo-controlled trial. Following a 4 week screening period, patients with mild cognitive impairment (MCI), who are clinically at risk for development of Alzheimer's disease, will be randomized to treatment with either placebo or galantamine for 24 months with either placebo or a flexible dose of galantamine. Efficacy will be evaluated by measures of memory and cognition (Alzheimer's Disease Assessment Scale of cognition for MCI [ADAS-cog/MCI] and the Clinical Dementia Rating Sum of the Boxes [CDR-SB]), global severity of dementia (Clinical Dementia Rating [CDR]), functionality (Alzheimer's Disease Cooperative Study - Activities of Daily Living adapted to MCI [ADCS-ADL/MCI]), and changes on serial magnetic resonance imaging (MRI). Safety will be assessed using adverse event reports, vital signs, laboratory parameters, physical examination and electrocardiograms. The primary study hypothesis is that galantamine will improve memory deficits associated with mild cognitive impairment and therefore improve or stabilize the patient's cognitive abilities. A second study hypothesis is that treatment with galantamine slows or delays conversion of mild cognitive impairment to the dementia often associated with probable Alzheimer's disease in these patients. The third study hypothesis is that the treatment will be well tolerated by the patients. Galantamine hydrobromide immediate-release tablets (4, 8, and 12 milligrams (mg)) taken by mouth 2 times daily: 4 weeks at 8mg/day, 4 weeks at 16mg/day, increased to 24mg/day for the remainder of the 24-month trial. Dose may be reduced at investigator's discretion after 12 weeks.

Inclusion Criteria:

• Clinical decline of cognitive ability consistent with mild cognitive impairment
• Delayed recall score less than or equal to 10 on New York University paragraph recall test
• Sufficient visual, hearing and communication capabilities and willingness to complete serial standard tests of cognitive function
• Have a consistent informant to accompany them on scheduled visits
• Be able to read, write and fully understand the language of the cognitive scales used in the study

Exclusion Criteria:

• Contraindications for magnetic resonance imaging, for example, presence of pacemaker or presence of metal in high risk areas
• Neurodegenerative disorders such as Parkinson's disease
• Cognitive impairment resulting from acute cerebral trauma, hypoxic cerebral damage, vitamin deficiency states, infections such as meningitis or AIDS, or primary of metastatic cerebral neoplasia
• Significant endocrine or metabolic disease
• Mental retardation
• Women who are pregnant, nursing, or lacking adequate contraception